In addition to providing support and education for patients prior to their outpatient surgeries, part of my role as a CCLS in an outpatient ENT clinic is to also help parents in how to talk to their children about their scheduled surgery. Many parents are hesitant to talk to their children about a planned surgery for fear of increasing anxiety and nerves. Many times I have heard parents say, “What if I tell him we are going to grandma’s instead of telling them he has to have surgery?” or “She knows she is getting her tonsils out, but I haven’t told her anything in detail because I don’t want to make her nervous.”
Both of these approaches and any in between are all in the best of intentions. No parent wants to build fear in their child. However well intentioned, these approaches may actually cause more anxiety. So the question many parents have is: Where is the balance? How do I ensure my child has the appropriate amount of information to make her feel confident and safe, but also not increasing her fear?
My child is really scared when we talk about surgery. How do I start the conversation without making him more upset?
First, I always let parents know that it’s okay for their child to be afraid. As an adult when I have a surgery or other procedure scheduled, I am nervous- even working in healthcare and knowing everything to expect! Validating your child’s emotions surrounding their surgery is a great first step in building your child’s confidence and sense of safety. Following validation up with simple and concrete explanations helps clear up and misconceptions as well as gives a sense of control and awareness of what to expect.
I tell parents that a great place to start when thinking about how to support children when preparing for surgery is to think of the 5 senses. What might your child see, hear, feel, etc. on the morning of their surgery? This gives solid sensory information that prepares your child for a potentially new environment.
What about needles?
This is a question I get often from parents. Surgery often means an IV is needed for fluids, medication and sometimes induction. Typically, an IV is not needed or commonly used as a method of anesthesia induction if a child is under 10 years old. However,this is an important detail to clarify with your provider, hospital or surgery center. Don’t hesitate to ask what their policy is regarding anesthesia induction and the use of mask versus IV.
When a child is receiving anesthesia induction through a mask, they may still have an IV but this will be placed once they are asleep and unable to feel any pokes. I encourage parents to talk about the “tube and tape” that will be on their hand or arm when they wake up. This will decrease the element of surprise.
The anesthesia mask is often compared to a nebulizer or CPAP mask. If these are items your child is familiar with this is a great comparison. The mask has a soft, air-filled “pillow” that goes around your child’s nose and mouth. The mask itself will smell like a plastic beach ball, but when hooked up to the anesthesia, it will smell strong, similar to nail polish remover. Sometimes hospitals and surgery centers will have flavor-scented masks for children or fruity scents that can be added to the mask. This is another great question to ask your provider or nurse.
The IV is a bendy straw that allows nurses and doctors to give your body drinks of water and any medicine that may be needed to make you feel better. It is also how older children will received their anesthetic or “sleepy medicine.” Especially for older children, I like to focus on the benefit and job of IV.
When an IV is placed, the nurse will start by looking at your child’s hand or arm. She will wash the area using a cold alcohol pad or cleaning solution. A large rubber band called a tourniquet will be used to help hug the veins to make them bigger and easier to see. The IV, or bendy straw is surrounding a needle that helps the IV slide into the vein. Once placed, the needle comes out and does not stay in the arm. Then the nurse will tape the IV and tubing in place so it does not move or fall out.
There are many pain management and numbing techniques out there that can be used to help ease the pain of an IV placement. These options include injected lidocaine, lidocaine creams (i.e. LMX or Emla), “freeze spray,” etc. Ask your nurse about any pain management or numbing options if an IV is needed.
Preparing Children of Different Ages + Stages
Preparing a 5 year old is going to look much different than preparing a teenager for a surgery. Additionally, responses to the stress and nerves that come with an anticipated surgery look much different for different age groups.
Resources I Love
In addition to the Parent’s Guide (available to download below), there are a variety of other materials and resources that I use to prepare children for surgery. These include a “My First Surgery” certificate, Coloring/activity book from the American Society of Anesthesiologists, and children’s books. All of these resources can be found below!
Give Play Love Resources:
American Society of Anesthesiologists Resources:
- Please Explain Tonsillectomy & Adenoidectomy to Me: A Complete Guide to Preparing your Child for Surgery, 3rd Ed. – Laurie & Perry Zelinger
- Goodbye Tonsils – Juliana Lee Hatkoff & Craig Hatkoff
- The Surgery Book for Kids – Shivani Bhatia, MD
- Surgery Day – Julie Kaderabek
- A Sleepy Tale: My First Surgery
- Ollie’s Tonsils – Tony Densley & Niki Palmer
- Tony’s Tonsillectomy – Wendy J. Hall
- Welwyn Ardsley & the Cosmic Ninjas: Preparing your Child & Yourself for Anesthesia & Surgery
- Emerson Learns about Surgery – Erica May